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Health Reform Agenda Advances in Iowa

Health Reform Agenda Advances in Iowa

Thursday, March 26, 2009

PERMALINK: http://www.progressivestates.org/node/22910

Valuing-Families

By: ADAM THOMPSON

Health Reform Agenda Advances in Iowa

Prior to last Monday's White House health care forum in Des Moines, Iowa, one of five regional forums being held across the country, the Iowa Senate passed two significant health care reform measures - one symbolic and one substantive. 

Resolution for Federal-State Collaboration on Health Reform: The Iowa Senate passed a resolution calling on "state governments and the federal government to collaborate with one another to reach the goal of providing quality and affordable health care to all Americans."  The resolution, authored by Sen. Jack Hatch, included a specific list of "guiding principles" that should be part of any national health care policy, including:

  • cost containment strategies - such as improved chronic care management and national electronic medical records
  • access to coverage for all - through public and private options and limiting a family's total health care costs to an affordable percentage of household income
  • improved quality -  including comparative effectiveness research and eliminating health disparities

The resolution envisions a strategic federal/state collaboration to solving the health care crisis in America and calls for federal reform that supports "state innovation by creating robust national standards that serve to raise the floor of state action, rather than limit state efforts to achieve the goal of quality and affordable health care for all."

Moving towards Comprehensive Health Care: The Iowa Senate followed the resolution with passage of SF 389, one of the most comprehensive health care bills moving in states this year. Also sponsored by Sen. Hatch, the legislation builds on a 2008 law that created a path for Iowa to achieve health care for all kids and address health care cost and quality.  Making a big step towards those goals, SF 389 will extend eligibility for public programs to children in families up to 300% of the poverty line, covering 30,000 of the state's 40,000 uninsured kids, and establish a "soft" mandate that eligible children be signed up (there are no penalties for parents who fail to enroll their children).  Funding for the expansion comes from $8 million in state funds and increased federal support through the SCHIP reauthorization and the federal stimulus package.

Notably, SF 389 includes substantive measures to rein in prescription drug costs, improve the quality of care, and design more options for coverage for businesses and families.  Highlights include:

  • The "Iowa Insurance Exchange" charged with designing more affordable coverage options provided through public and/or private health plans
  • A health care workforce support initiative and workforce fund under control of the College Student Aid Commission
  • A prescriber education program to provide medical professionals with scientific and evidence-based clinical information about medications
  • A prohibition on gifts to medical professionals from the pharmaceutical and medical device industries
  • Strengthened privacy protections in the use of prescription-use data (related to industry data-mining), and  
  • Transparency provisions, including the requirement that for-profit hospitals and nursing facilities submit annual reports akin to 990 forms provided by non-profit facilities, greater reporting of hospital patient flow and related information, and a health care quality and cost transparency workgroup to identify ways to improve quality and cut health care costs.

As a sign of what's to come in the national health care debate, Republicans en masse opposed SF 389 and charged, "This bill leads us down a pathway to socialized medicine."  Sen. Majority Leader Mike Gronstal dismissed the accusation as "tired", an apt description of the hackneyed accusation conservatives have made against substantive reform since at least the Truman Administration. What shouldn't be missed in the political debate surrounding the measure is that, if enacted, SF 389 will result in Iowa's businesses and families having more options and choices for coverage - a key priority for voters.  SF 389 is now before the Iowa House.

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Increasing-Democracy

By: CHRISTIAN SMITH-SOCARIS

New Revelations Provide More Evidence Paperless Voting Not Safe

Three recent revelations about electronic voting machines highlight the maddening lack of security in paperless elections, and emphasize why paper ballot voting with robust post-election audits are a basic requirement for secure elections.

The Premier "Delete" Button, Discarding Votes Made Easy:  The California Secretary of State's Office recently completed their investigation on the cause of almost 200 lost votes in the 2008 general election in Humboldt County.  Faulty software from Premier Election Solutions (formerly Diebold) was to blame, as it was in Ohio.  Both California and Ohio are suing Premier over the botched product.  Premier originally denied there were any flaws in its software, alternately blaming the issue on user error and anti-virus software, but has now acknowledged they are at fault.

The investigation, however, uncovered an even more troubling problem - the machines used in Humboldt County and elsewhere had an erase button that allowed the machine's audit logs to be "zeroed out" with the touch of a button.  Not only does such a capability fatally undermine the security of these machines, they were built in such a way that votes could be deleted without election workers noticing they had done so.  Premier was even made aware of the insanity of including such a function in their machines.  An e-mail from one of the system's developers stated that "adding a Clear button is easy, but there are too many reasons why doing that is a bad idea."

The report on this fiasco by the Sec. of State sums up the scope and depth of the problem this way:  "The Clear buttons ... allow inadvertent or malicious destruction of critical audit trail records in all Gems version 1.18.19 jurisdictions, risking the accuracy and integrity of elections conducted using this voting system. Five years after the company recognized the need to remove the Clear buttons from the GEMS audit log screens, not only Humboldt, San Luis Obispo and Santa Barbara Counties in California but jurisdictions in other parts of the country, including several counties in Texas and Florida, continue to use Gems version 1.18.19...."

CIA Cybersecurity Expert Warns Electronic Voting Inherently Insecure:  A CIA cybersecurity expert who specializes in assessing foreign threats to US election systems has warned the federal Election Assistance Commission that electronic voting is inherently insecure.  Steve Stigall was testifying on the likely rigging of electronic machines that has occurred in Venezuela, Macedonia, and Ukraine when he attacked the security of electronic voting in general.  According to a transcript of the hearing obtained by McClatchy Newspapers Stigall said, "[y]ou heard the old adage 'follow the money'?  I follow the vote.  And wherever the vote becomes an electron and touches a computer, that's an opportunity for a malicious actor potentially to . . . make bad things happen."

Public Officials in Kentucky Indicted for Stealing Electronic Elections:  Political corruption and vote buying have been alleged in Clay County Kentucky for decades.  In an effort to counteract that tradition, the Department of Justice has indicted several public officials - including a judge, the county clerk, the school superintendent and members of the elections board — on vote buying and election fraud.  According to the indictment, the defendants not only conspired to steal elections the old fashioned way, but also exploited a vulnerability in their new ES&S iVotronic paperless voting machines.  The defendants are alleged to have duped voters into leaving the voting booth after they had pressed the "vote" button, which doesn't actually cast the vote, but brings up a review screen where a voter confirms their selections.  Once the voter had left the booth, corrupt election workers went in and changed their votes.

This case is significant for a couple reasons.  The first is that the major defense used by voting machine vendors regarding the flaws in their products has been that none of the problems have ever resulted in a stolen election.  If the DOJ is correct, several elections were stolen in Kentucky on electronic machines.  Second, the fact that using electronic voting machines is confusing enough that a many voter can be tricked into leaving the booth before they have actually cast their ballot is a critical vulnerability in these systems that has not previously been appreciated.

Revelations like those outlined above just add to the overwhelming evidence that elections without paper records cannot be secure.  And while a majority of voters in the US now cast their ballots on paper, there are still a large number of voting jurisdictions that plug their ears to the growing drum beat of warnings and defend these indefensible voting systems.  Progressive leaders in these states must stand up for the rights of their constituents to free and fair elections by demanding paper ballot elections that create a permanent record of the votes, as well as strong post-election audits to detect any errors or fraud.

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Valuing-Families

By: MARISOL THOMER

New England Leads Fight for Marriage Equality

On Monday, March 23rd, the Vermont Senate overwhelmingly passed (26 to 4) a bill legalizing same-sex marriage, making the state the first in the nation to take legislative rather than judicial steps toward granting marriage rights to same-sex couples.  Although House Speaker Shap Smith was confident a majority of representatives would vote in favor of the "marriage equality" act, Governor Jim Douglas revealed in a press conference Wednesday that he would veto the bill, though he did say he would accept a legislative override.  Speaker Shap, however, was less than confident about a veto-proof majority.  Nearly a decade ago, Vermont became the first state in the nation to enact civil unions for same-sex couples.  The current bill would end the separate institutions of civil unions and marriage, granting equal marriage rights and recognition to all committed couples.

The New Hampshire House of Representatives will vote today on a bill similar to Vermont's, and next month a legislative panel in Maine will hold a hearing on a bill to allow gay couples to marry, just as lawmakers did last month in Rhode Island.

Last year, Connecticut joined Massachusetts to become the second state in the country to allow same-sex marriage.  Only Vermont, New Hampshire, New Jersey, and California currently permit civil unions.  A court decision last year briefly allowed same-sex marriage in California, but the passage of Proposition 8 in November banned it.

The Minnesota House of Representatives is scheduled to hear four bills relating to gay marriage, including a bill to recognize same-sex marriages performed in other states, a bill that allows civil unions, and a bill that takes away gender-specific references to marriage in Minnesota Statutes, effectively doing away with the the Defense of Marriage Act (DOMA) currently on the state's books.

Movement on Civil Unions and Domestic Partnership Legislation: Hopes that the Hawaii legislature would grant civil unions the same rights and benefits as marriage were dashed when senators yesterday refused to buck Senate President Colleen Hanabusa's opposition to a maneuver that would have allowed the bill to come to a full Senate vote.  On February 12th, the Hawaii's House had passed HB 444 with a 33-17 vote, but the bill then stalled in the Senate Judiciary Committee with a tie vote.  The motion to pull the bill out of committee and to a full Senate vote is extremely rare -- it was last done 10 years ago -- and after leadership's lobbying against overriding the normal lawmaking process, the maneuver failed to pass by 3 votes.  About 18 of the 25 senators, including Hanabusa had indicated they support civil unions. 

Out West, some states have been moving to advance domestic partnership legislation:

  • A Colorado bill to allow two adults, regardless of sex, to enter into "beneficiary agreements" passed that state's senate on Monday with two Republicans joining senate Democrats to pass the measure. The bill would allow two people the right to file an agreement with their county clerk that would grant them rights to inherit and make medical decisions.  In 2006, Colorado voters defeated a measure that would have given same-sex couples more of the rights and responsibilities of marriage.
  • A Nevada bill set for a hearing tomorrow before that Senate Labor and Commerce Committee would create domestic partnerships defined to give partners the same rights, protections and benefits as married couples.
  • A measure to grant a legal status to domestic partnerships failed in the New Mexico Senate last month.

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Research Roundup

Still Open for Business: Unionization Has No Causal Effect on Firm Closures - This Economic Policy Institute briefing paper offers overwhelming evidence that unionization does not cause businesses to fail.  When you compares data on business failures among unionized and similar nonunion firms and concludes that unionized businesses are no more likely than nonunion ones to fail.

A few new key reports on health care:

  • How Effectively Does the American Recovery and Reinvestment Act Help Laid-Off Workers and States Cope with Health Care Costs? - This Urban Institute study finds that the stimulus package will likely provide only a limited increase in the number of unemployed workers receiving health coverage under the COBRA Act and provides nothing for laid-off workers who are ineligible for COBRA.  Most of the relief for the unemployed will come from increased funding for Medicaid.
  • The Cost Shift from the Uninsured - According to this Center for American Progress memo, eight percent of families’ 2009 health care premiums—approximately $1,100 a year— are due to our broken system that fails to cover the uninsured. A a more efficient system that offers continuous, quality coverage for all would ultimately lower the costs of health care for everyone.
  • The Inefficient Individual Health Insurance Market - The individual market of private health insurance racks up the highest administrative costs in the health care system-- with 29% of spending going to administrative costs --  often due to the fact that insurance companies invest a lot of money screening applicants to deny coverage to less healthy people.  The report highlights why any health care reform needs to give everyone access to some form of group coverage to lower these adminstrative costs.
  • Medicaid and CHIP Eligibility Is Protected For Jobless Families That Receive Boost in Unemployment Benefits (CBPP) - The 17.9 million jobless workers receiving an additional $25 per week in unemployment insurance benefits under the ARRA can exclude that additional income when determining eligibility for Medicaid and CHIP, helping some low-income families access health care they might otherwise have been excluded from, although the income will be taken into account when calculating food stamps/SNAP benefits.

2009 State-by-State Teen Dating Violence Report Card - This report by Break the Cycle finds that teens facing dating violence often are not recognized under most states laws as facing domestic abuse or being able to access the same legal and social services support as adults.  Only five states -- California, Illinois, Minnesota, New Hampshire and Oklahoma -- received A grades in the report, while eleven states received grades of failure to defend teens from dating violence.

Wage and Hour Division’s Complaint Intake and Investigative Processes Leave Low Wage Workers Vulnerable to Wage Theft - This scathing report by the U.S. Government Accountability Office (GAO) highlights the systematic failure of federal employment laws to protect low-wage workers facing minimum wage and overtime abuses by employers-- highlighting the need for both federal reforms and stepped up efforts by states to better enforce their own laws.

Our Economy Needs Family Values at Work Now More than Ever - This fact sheet by Family Values at Work highlights that two-fifths of all private sector workers and 3 out of 4 low-wage workers have no paid sick days, while legislation to require paid sick days would actually reduce overall business costs through health care savings and increased productivity.

Driven by Dollars - This Pew Center on the States study analyzed Pennsylvania’s recent debate about leasing its turnpike as a case study on the standards needed for discussing any kind of transportation leasing relationships with the private sector, including realistic financial assumptions, real oversight mechanisms involving transparency and accountability, and long-term projections of the effect on taxpayers, the economy and the environment.


Please email us leads on good research at research@progressivestates.org

Resources

Iowa Advances Health Reform Agenda

Senate Resolution 13 - Encouraging a Federal/State Collaboration to Achieve Quality, Affordable Health Care for All
Progressive States Network - Strategies to Extend Coverage to Uninsured
Stateside Dispatch - Rx Policies: Cut Health Care Costs and Promote Broader Health Care Reform
Progressive States Network - Implementing the Recovery Plan: A Resource Guide for State Legislators and Advocates

New Revelations Provide More Evidence Paperless Voting Not Safe

Progressive States Network - Paper Ballots
Progressive States Network - Post-election Audits
Wired - Report: Diebold Voting System Has 'Delete' Button for Erasing Audit Logs
California Secretary of State - Report Concerning Errors and Deficiencies in Diebold/Premier GEMS Version 1.18.19
McClatchy Newspapers - Most Electronic Voting Isn't Secure, CIA Expert Says
Brad Blog - KY Election Officials Arrested, Charged with "Changing Votes at E-Voting Machines"

New England Leads Fight for Marriage Equality

Gay & Lesbian Advocates & Defenders (GLAD) - Resources on New England Marriage Legislation
Human Rights Campaign (HRC) - Maps of State Laws & Policies
Progressive States Network - Gay Marriage - In the Courts, On the Ballot

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The Stateside Dispatch is written and edited by:

Nathan Newman, Interim Executive Director
Caroline Fan, Immigration and Workers' Rights Policy Specialist
Julie Schwartz, Broadband and Economic Development Policy Specialist
Christian Smith-Socaris, Election Reform Policy Specialist
Adam Thompson, Health Care Policy Specialist
Julie Bero, Executive Administrator and Outreach Associate
Austin Guest, Communications Specialist
Marisol Thomer, Outreach Coordinator

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